Updated 18 February 2013

Coca (Erythroxylum coca)

The coca plant (Erythroxylum coca), or "coca," is native to the Andean region in western South America. Coca leaves have been used widely by native South American tribes for thousands of years. It has been suggested that the use of the coca plant was originally reserved for priests and royalty in ancient South America and was used for religious purposes.

Note: There are four plants from the Erythroxylum family that are typically grown for cultivation in South America, including E. coca var. coca, E. novogranatense var. novogranatense, E. coca var. ipadu, and E. novogranatense var. truxillense.

This monograph includes information on the coca plant and coca plant products, such as coca leaves, coca leaf tea, as well as cocaine. Coca leaves and cocaine are two different substances. Cocaine is an alkaloid present in the leaves of the coca plant. Cocaine powder, an addictive stimulant, has the potential for being toxic, particularly in large quantities or with long-term use. Cocaine abuse has resulted in increased illness and death.

The growth, sale, and possession of cocaine are illegal in most countries. Unprocessed coca leaf, however, may be legal in some South American countries because the use of coca leaves has traditionally been considered to be a part of the local cultural identity, especially for specific indigenous groups. As a preventive measure against cocaine production, coca plant cultivation is often limited in South American countries.

This monograph does not include information on prescription cocaine hydrochloride.

BACKGROUND

The coca plant (Erythroxylum coca), or "coca," is native to the Andean region in western South America. Coca leaves have been used widely by native South American tribes for thousands of years. It has been suggested that the use of the coca plant was originally reserved for priests and royalty in ancient South America and was used for religious purposes.

Traditionally, coca plant products (for example, coca leaves, coca leaf tea) have been used for reducing pain, decreasing hunger, and for their stimulant effects. Cocaine, an alkaloid that is processed from the coca plant, is a highly addictive stimulant. In 1999, an estimated 30% of drug-related visits to emergency departments were due to cocaine toxicity. Cocaine production and trade is illegal in most countries. Unprocessed coca leaf, however, may be legal in some South American countries because the use of coca leaves has traditionally been considered to be a part of local cultural identity, particularly for specific indigenous groups. To prevent cocaine production, coca plant cultivation is often restricted in these countries.

Coca leaves have been used for treating cocaine dependence. Coca leaves have also been used for studies of exercise tolerance and hypoglycemia. Use of illicit cocaine has had negative effects on antisocial behavior and general health. Further study is needed.

EVIDENCE TABLE

Conditions

Uses
disclaimer:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grade*

Cocaine dependence

Coca leaves have been suggested as possible treatments for cocaine and cocaine base abuse. Further study is needed before a conclusion may be drawn.

C

Exercise performance

The effects of coca use on hormonal and metabolic responses to exercise have been studied. Preliminary evidence shows that coca use may enhance exercise tolerance. Further study is needed before conclusions may be drawn.

C

Hypoglycemia (low blood sugar)

Preliminary human studies show that chewing coca leaves may improve hypoglycemia. In animal study, nonalkaloid fractions of coca produced hyperglycemia (high blood sugar). Further study is needed before a firm conclusion may be drawn.

C

*Key to grades:
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

DOSING

disclaimer:
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

General: Drinking coca tea is a common practice in several South American countries. Coca tea bags normally contain about a gram of leaves.

Cocaine dependence: Chewing 100 to 200 grams of coca leaf per week for about 27 months has been used.

Exercise tolerance: In one study, an average of 16 grams of coca leaves was chewed for one hour. In another study, subjects chewed 15 grams of coca leaves (yielding 0.4%-0.7% cocaine) for one hour. "Unlimited" or "usual" amounts of coca leaves have both been chewed for one hour. The amount of coca leaves chewed by the treatment group was obtained by subtracting the weight of the subjects' supply of coca leaves after chewing from the weight of their initial supply before chewing. In another study, habitual coca chewers were given the amount that they "normally" chewed, and "non-chewers" were given 4.5 grams; chewing lasted for one hour.

Children (under 18 years old)

Insufficient available data.

SAFETY

disclaimer:
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with known allergy to coca (Erythroxylum coca), its constituents (including cocaine), or members of the Erythroxylaceae family.

Side Effects and Warnings

Note: Avoid use of coca leaf tea and illicit cocaine-containing products; although it is used in specific pharmaceutical preparations, cocaine produced outside of the pharmaceutical industry is illegal in most countries including the United States.

Coca leaves: Chronic chewing of coca leaves may lead to a cycle of malnutrition, tiredness, and illness, as well as dental and skin problems. Increased heart rate and blood pressure have also been noted with use of coca leaf products. Patients that have diabetes or are using diabetic drugs should use coca leaf products cautiously, as they have been reported to increase blood sugar levels. Although coca plant products have been suggested as a source of nutrition, human study suggests that chronic chewing of coca leaves may cause malnutrition.

Cocaine: Heart problems are one of the most common reported side effects of long-term cocaine use or overdose. These may include irregular heartbeats, abnormally fast heart rate, heart attack, stroke, and death. Other common reported side effects of using large amounts of cocaine include restlessness, mood swings, migraines, seizures, hallucinations, and psychosis (mental deterioration). Other problems from long-term cocaine use may include kidney, nose, and skin problems. Patients that also use alcohol or tobacco should avoid using cocaine, because using these together has resulted in increased liver toxicity, irregular heartbeats, heart attack, heart failure, and death.

Coca leaves or cocaine: Patients that have cardiovascular (heart) or blood pressure issues, or those that use drugs that affect blood pressure should avoid using coca leaves or cocaine, as both have increased heart rate and blood pressure. Patients that use stimulants should avoid use of coca leaves or cocaine. Patients that have a known allergy/hypersensitivity to coca (Erythroxylum coca), its constituents (including cocaine), or members of the Erythroxylaceae family should avoid use of coca. Patients who are pregnant should avoid using cocaine or coca leaf products, as cocaine use during pregnancy has increased the risk of birth defects, separation of the placenta from the uterus, premature labor, and death of the fetus. Avoid cocaine or coca leaf products in lactating women, as cocaine has been found in breast milk.

Pregnancy and Bre
astfeeding

Avoid cocaine or coca leaf products in pregnant women, as cocaine use during pregnancy has increased the risk of birth defects, separation of the placenta from the uterus, premature labor, and death of the fetus. Avoid cocaine in lactating women, as cocaine has been found in breast milk.

INTERACTIONS

disclaimer:
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Human reports suggest that using alcohol, tobacco, and cocaine together increased the risk of liver problems, heart problems, and death.

Cocaine has anesthetic (numbing) effects and has been used topically as a numbing agent, particularly for specific surgeries. Caution may theoretically be warranted with use of anesthetics.

Patients who use antidepressants should use cocaine-containing products cautiously.

The coca plant is a natural source of cholinesterase inhibitors. Caution may theoretically be warranted with use of cholinergic agents.

Coca leaf products have been reported to raise blood sugar levels. Caution may theoretically be warranted with use of drugs that affect blood sugar levels.

Use of coca leaves has increased heart rate and blood pressure. Caution is warranted in patients that use blood pressure drugs.

Coca plant products have caused weight loss. Caution with use of weight loss drugs is warranted.

Delta-9-tetrahydrocannabinol counteracted cocaine's immune effects.

Stimulants and cocaine have interacted. Theoretically, an additive effect may occur. Patients that use stimulants should avoid use of cocaine.

Coca tea contains tannic acid. Tannins may inhibit the absorption of metals such as iron, zinc, and copper.

Coca-leaf chewing affected salivary progesterone; caution may be used with use of progestins.

Interactions with Herbs and Dietary Supplements

Human reports suggest that using alcohol, tobacco, and cocaine together increased the risk of liver problems, heart problems, and death.

Cocaine has anesthetic effects and has been used topically as a numbing agent, particularly for specific surgeries.

Patients who use antidepressants should use cocaine-containing products cautiously.

The coca plant is a natural source of cholinesterase inhibitors. Caution may theoretically be warranted with use of cholinergic agents.

Coca plant products have caused weight loss. Caution with use of herbs and supplements for weight loss is warranted.

Delta-9-tetrahydrocannabinol counteracted cocaine's immune effects.

Use of coca leaves has increased heart rate and blood pressure. Caution is warranted in patients that use herbs and supplements that affect the heart or blood pressure.

Coca-leaf chewing affected salivary progesterone; caution may be used with use of phytoprogestins.

Coca tea contains tannic acid. Tannins may inhibit the absorption of metals such as iron, zinc, and copper. Theoretically, coca may also have additive effects with other tannin-containing herbs or supplements.

Coca leaf products have been reported to raise blood sugar levels. Caution may theoretically be warranted with use of herbs or supplements that affect blood sugar levels.

Cocaine had insect repellant effects. Theoretically, it may interact with insect repellants.

Stimulants and cocaine have interacted. Theoretically, an additive effect may occur. Patients that use stimulants should avoid use of cocaine.

ATTRIBUTION

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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